Digital addiction is a real barrier to patient centred care

As another frantic holiday season approaches, we are reminded of the three stages of life: First you believe in Santa, then you don’t believe in Santa, then you are Santa. We are both willing actors in stage-three, and along with this came acceptance of an inconvenient truth: our parents were right all along. We had both spent four decades rolling our collective eyes as our mums delivered the same advice: “Just slow down.” Mum was right of course, mum is always right: right about parenthood, just as right about “doctorhood.”

One of these authors (PB) recently reviewed the book “Distracted Doctoring: Returning to Patient-Centered Care” by Papadakos and Bertman. [1] It offers lessons for both our personal and professional lives that would receive unwavering maternal approval. If you can find time from your other distractions, then you too will be rewarded and admonished in equal order. The book opens by explaining the concept of “digital harm”, and ends by imploring you—and me and us—to simply slow down and to be present. In the medical realm, this book warns cogently about how flesh-and-blood patients have become iPatients. The book also outlines how we are prone, perhaps even wired, to attend to the screen before the human. “Digital addiction” is not only real it is a real barrier to patient centred care. It is also a clear and present danger to our personal lives. Unfortunately, the problem is easier to diagnose than to cure. Moreover, without action it will only get worse.

It is dangerous to outsource deep-thought, to dilute face-to-face contact, and to believe that we can seamlessly multi-task. However, distraction and time pressure has long bedevilled professionals and parents alike. What is novel, and perhaps paradoxical, is the idea that easy-information can promulgate lazy-thinking. In the past, as doctors, we were forced to head to the library, to radiology, and to medical records. Late at night, it was worse still, as we likely had to waylay a security guard. These were major distractions—no doubt about it—but these limits forced us to prioritize, to rationalize, to think, and to think again. Now we reach for the phone in our pocket and our prefrontal cortex is given a bye. Like the holiday season we receive sack loads of stuff, but not necessarily meaning. It may be easy to inhabit “app-y” valley, but it is not without risk.

In the “attentional economy,” engineers and psychologists are actually incentivized to distract us. It is likely that companies and politicians wish to do the same. Regardless, it appears that we get a squirt of dopamine with each electronic diversion. This in turn primes our primate neural circuitry to desire more, and a vicious cycle ensues. Hyperbole aside this means that medical problem-solving and interpersonal relationships are under-siege from pocket dopamine machines. Even if it is not our fault, it is still our responsibility to control our attention. These authors believe we have reached the point where we need to redefine what it means to be a medical professional, an attentive parent, and an empathic partner. We must not use these “weapons of mass distraction” longer than is necessary or helpful. The computer and the phone must be our servant not our master.

We acknowledge that no physician, parent, or partner can know everything, and that we need data that is readily accessible and legible. However, we also believe it is time to see increased screen time as a relative failure, and to move past the specious idea that the computer is automatically mightier than the pen. You are not a Luddite is you forgo the latest in favour of the reliable. Moreover, our technology should pass a new digital test: does this deliver usable information quicker than erstwhile methods, does it encourage better documentation, and does it illuminate rather than obfuscate the human story? Above all, does it help me to focus on what matters most? If it fails these tests then it is not “fit for task.”

These two authors are issuing a Christmas challenge and a New Year’s resolution. During medical rounds—just as with family time—we will leave our phones behind and forego the comforting pocket vibration. We will prepare beforehand and we will read after. We shall maximize time with humans and downgrade the iPatient and iFamily. We will think until it hurts, and we will communicate face-to-face. In short, we will strive to be the doctors and family members that our patients need and our mothers expect. These two Santa-wannabes also wish you the gift of a restorative holiday, a digital reset, and a less distracted 2018.

Peter Brindley, professor of Critical Care Medicine, Anesthesiology and Pain Medicine, and Health Ethics, University of Alberta, Edmonton, Canada. @docpgb

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan

References:

[1] Brindley PG. A Book Review of “Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age”. Do we have time for this? Anaesthesia and Analgesia, Publication Pending 2018.